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HomeMy WebLinkAbout15-229CITY OF IOWA CITY 410 East Washington Street Iowa City. lona 52240-1826 (319) 356-5040 {319) 356-5497 FAX IDENTIFICATION NO (Office UseOnly) APPLICATION FOR TAXICAB 1 MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday) Failure to complete the "required" information will result in denial of the application Middle 1. Name (REQUIRED) - 2. Address (REQUIRED) I 3 Contact Information (REQUIRED) Email: (All 4a. Chauffeur's License expiration date (REQUIRED) b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of passengers: lone: Ilk g-e c, F# 3 6A 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhtgPe? Type o tt WT When rt. AV\r 1i6 <4S /R -Q- Iu IA. ^R., ,. r ,.. r ei A �^ \ 4-" i ) fl 7 What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other htl r �i l4 — 7 Have you been arrested / charged with any traffic offenses in the last five years? T eT e o� Where When ® v— - V � r"�CCL'• C�,"� �.'�� P:'��d � '. ei ��(�a:%/cam i W at- happened Qo the charge? (Circle one) Convicted Dismissed Deferred SuspendedPlead Gu OthW 8. Has yourr' Jlicen5e or chauffeur's license been suspended or revoked in the last five years? 4-1 Type of ef:3PT Where When o4' b t � 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide n7e(s) DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REVIEW You must apply for an individual Department of Criminal Investigation Report (form available upon request). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 02/2015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify that I h�e: is uedlt�o e by the Iowa Depart�je t of Transportation a valid hauffeur's license number o�S ff— ! JC issued on U / 677 Vj xpiring on n R US i. I understand that if I falsely answer any questions in this application, that this application may be denied. I agree that in m&ng this application, I consent to allow agents or employees of the City of Iowa City, Iowa, in their discretion, to examine any and all records and documents relating to this apgFNcation, and I further agree that, if authorization to be a taxicab driver is granted, to comply at all times with all of the provisiW,6��5, Chapter 2, of the City Code. (Needs to be signed in front of a NDtary Public) Signature of Applicant \ Date STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by C` 't; v', e €� f y y on this ,7) day of I have reviewed this application, DCI report, and the State certified driving record of this applicant and have determined that there is no information which would indicate that the issuance would be detrimental to the safety, health or welfare of resi- dents of the City of Iowa City (Title 5, Chapter 2, City Cod ). I Expiration date of Chauffeur's license O S ! 2 U k -1J 1A21 l Signature of Police Chief or designee Date AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN IOWA CITY FOR NO MORE THAN ONE YEAR FROM THE DATE LISTED BELOW. Signat f City Clerk or designee _ Office Use Only Approved application DCI report State certified driving record Website update �f' tef' to ClerkJ7AXIDRNEADGEAPPL52014amended.Doc 0312015 h.d V] ClerkJ7AXIDRNEADGEAPPL52014amended.Doc 0312015 REQUESTED BY: KAKERT, CHRISTOPHER 1809 Granttiaood Or Iowa Cry. lA 522AC KAKERT. CHRISTOPHER JOSEPH 3851 ROGER BROOKE 1131 ET SAM HOUSTON, TX 78234-0000 DRIVER LICENSE INFORMATION Driver License Number: TEXAS DEE AReY' int: EN ® OF 6PU26'UC S6'2- TE Date Originally Issued: E s "P II 5805 N. L,4I�AAR BLVD -BOX 4087 • AUSTddB, TEXAS 7$773-D�DD� yam) Endorsements: wwvt.dpsNSEDhgSION -R-1 / DRIVE PCENSE ©PVPSlQIat State: fA S12 -424-2f O STEVEN C..".icCRAW EN ESPANOL 512-4247181 ONi ID C, BAKER DIRECIaR CHERYL V=BRIDE °DEPUTY r ARECTORS 1v 3 YEAR HISTORY RECORD: 071OW2014 NO - THIS TYPE OF RECORD WILL NOT REFLECT COMPLE77ON OF A DRIVING SAFE T Y COURSE. EVENT 2 - THIS RECORD REFLECTS CONVICTIONS AND CRASH INVOLVEMENTS THAT ARE ALLOWED TO BE DISPLAYED 13Y LAW REQUESTED BY: KAKERT, CHRISTOPHER 1809 Granttiaood Or Iowa Cry. lA 522AC KAKERT. CHRISTOPHER JOSEPH 3851 ROGER BROOKE 1131 ET SAM HOUSTON, TX 78234-0000 DRIVER LICENSE INFORMATION Driver License Number: 28014674 License Type: DL Date Originally Issued: 11/24/2008 Date Last Issued: 0310212009 Restrictions: With Corrective Lenses Endorsements: NONE Date of Birth: 02i0511982 Sex: MALE Eye Color. HAZEL License Class: CM Date of Expiration: 02/05/2015 STATUS INFORMATION Orlver etrgi ,W reflects a person's ettpibi* to drive at the lime this cf um E vas requested. Administrative Status details additional notes related to the person's record Thai do not affect drrong eigtbit.ey. Driver Eligibility: ELIGIBLE Administrative Status: NONE EVENT HISTORY This section displays lnrorma&an moyng to cnnwc&ans and crash Inm4mment EVENT 1 CONVICTION SPEEDING - SPEED LIMIT AND ACTUAL SPEEI03Q�TAFZ' REtdU_gED) Offense Date: 03/20/2012 Conviction Date: 0510212012 State: fA a Reference 5021STA000 w Number: 1v CMV: NO HAZMAT: NO CDL: WO EVENT 2 CONVICTION SPEEDING -SPEED LIMIT AND ACTUAL SPEED (DETAIL REQUIRED) Offense Date: 11/2112011 Conviction Date: 12/20/2011 State: JA Reference STA0031403 Number: CMV: NO HAZMAT: NO CDL: NO End of Record Page 1 r1 Iowa Department of Transportation [Yy U¢nrr of 07kver zWrm(ti ; Y'Al F (Lei 4G S3Y 1'21 —li Fl:j go. 03204, Ucs Mout) s.,'A 5)005 17+2�t tiIt 244 .41-24 iFLAX 51:.11391,33` Certified Abstract of Driving Record Inquiry Date: 9/21/2015 DL/ID #: 713YY7401 QA) Customer 9: 4128411 Name: Kakert, Christopher Class: D ID Status: EXP Joseph Address: 1809 GRANTWOOD Audit #: 8236251 DL Status: VAL DR Convictions CDL Status: None Conviction Date Issue Date: 07/08/2014 City/State: IOWA CIN, IA Expiration Date: 02/05/2019 CDL Med Status', 522405959 _,-Non�i� IIA Restriction y,.-. �—None Endorsements: 3L Mailing Address: 1809 GRANTWOOD Restrictions: NONE DR Date of Birth: 2/5/1982 Mailing IOWA CITY, IA Sex: M City/State: 522405959 History Information Convictions CDL Status: None Conviction Date r-� Explanation CDL Cert Status: Nont JUR 05/09/2015 106/22/2015 CDL Med Status', (Speed _,-Non�i� IIA Restriction y,.-. �—None Supplement: r r_-! Citation Date Conviction Date ACD Explanation Count JUR 05/09/2015 106/22/2015 _ _ 592 (Speed (Johnson IIA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 07/22/2014 808929 IA 02/25/2015 847894 IA Name: Kakert, Christopher Joseph DL/ID: 713YY7401 Pursuant to Iowa Code §32110, I, Kim Snook, Director of Office of Driver Services, Iowa Department of Transportation, do hereby certify that I am the custodian of the records held by the Office of Driver Services, that this is a true and accurate copy of an official record currently in the custody of said Office, and that I have been authorized by the Director of the Iowa Department of Transportation to so certify. In witness whereof, I have caused my signature and the seal of the Department to be set upon this document, at Ankeny, Iowa this date: kiy� 9/21/2015 D. 0. T ~� 4yu&�Ya Office of Driver Services Iowa Department of Transporation Name: Kakert, Christopher Joseph DL/ID; 713YY7401 rw 0 i^r7 v W .. Rl SeP.17. 2015 9:25AM Div of Criminal Investigation N0,6071 P. lil Fruu...f .y ... ...w .-..y Cl orn .u... u.. - iv esu --v. oa/l5 /2 t)t6 IS:, 126, r-.uu.y/002 STATE OFIONVA Criminal T-Ttst-ol-y Request Pot -in T U: IOv-a D WiLino of Cmnig8l II)vCSI i946un 5uP0m'f Qpera(klys 13urrau, 1" Flour 2I5 Eti. TI`5free� Des Molner, Iowa 50319 (515)725-6066 (515) 725-665(1 Fax ll(?I Account Alumbcr L_/c�(�y� Jam_ Y pfapplibablt) From: (:i['ufluWaCifV Cily Cleric% Office 410 1;. �Kras3air�glan ,W'IrCel - luua City, [A 52240 Phone: 319-156-5041 _ Fara 319-356.5497 —'--- ,urwit %--.runipaf moory Record Check Results - As of` _ I I I a searcl, of the provided name and dale of birth revealed; No Iowa Criminal I isfory Rccord found 3j d3S �I�Z ® lov'a Crinlival 1listur}' I?tcord alinhad, 1) f1 A= DCI I)C1-77 (0f/25/10) Received Time Sep, 15, 2015 3 25PN filo. 8026